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MedPAC Debates Best Way to Replace MIPS

News  |  By MedPage Today  
   November 03, 2017

Most members want MIPS repealed, but some concerned about its proposed replacement

This article first appeared November 2, 2017 on Medpage Today.

By Joyce Frieden

WASHINGTON — Although most members of the Medicare Payment Advisory Commission (MedPAC) continue to support repealing Medicare's new Merit-Based Incentive Payment System (MIPS) for physician payment, there was disagreement Thursday about what should replace it.

At a morning meeting, MedPAC staff members presented more details about a proposed replacement for MIPS called the Voluntary Value Program (VVP), and addressed concerns that commission members raised about the program at their last meeting.

MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use, and clinical practice improvement. Under MIPS, doctors earn a payment adjustment based on evidence-based and practice-specific quality data that they report to the Centers for Medicare & Medicaid Services (CMS).

Issues with MIPS

But MedPAC members are concerned that MIPS will not achieve its desired goals. The flexibility of the program — the various options for how physicians can report measures and the broad exemptions for certain types of clinicians — has also made it complex. There are also statistical challenges that stem from trying to develop individual-level performance scores, due to the relatively small case sizes for some providers, David Glass, a principal policy analyst for MedPAC, told the commission during its October meeting:

"Everyone will seem to have high performance when in fact many of the measures are topped out or appear to be topped out ... and that will limit Medicare's ability to detect meaningful differences in clinician performance," he said.

And, speaking at the Thursday meeting, Glass said the program will likely cost about $1 billion in the first year, noting that the commission has raised concerns about the program for the past 2 years.

Under the VVP proposal, all clinicians would see a portion of their fee schedule dollars withheld and lumped into a pool. Clinicians could then be measured with a group of other doctors -- based on population-based outcomes, patient experience, and cost -- to be eligible for value-based incentive payments from the pool. Otherwise, they could decide to participate in an advanced alternative payment model (AAPM) program -- an option they have under the current reimbursement system, in which groups of physicians and hospitals can earn a bonus of up to 5%, based on patient outcomes, in exchange for taking on financial risk. If they chose neither of those options, they would lose all the money withheld.

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